Lavage and cytology instrument

ABSTRACT

A device for use in proctosigmoidoscopic examinations for directing a pressure liquid, such as water, a saline solution and/or diagnostic dyes to a predetermined proctosigmoid zone and for withdrawing the injected fluid, feculent and mucoid debris associated therewith including first and second hollow parallel nonconcentric tubular members, means connecting one of the tubular members to a source of liquid under pressure and further conduit means selectively connecting the other of the hollow tubular members to a source of reduced pressure and/or a collector maintained at a reduced pressure. The withdrawing function and/or spraying may be continuous or intermittent.

United States Patent [191 K 51 Ma 29, 1973 LAVAGE AND CYTOLOGY FOREIGN PATENTS OR APPLICATIONS INSTRUMENT 865,064 4/ 1961 Great Britain 128/276 Inventor: Seymour Katz, 444 East 68th Street,

New 10021 Primary Examiner--William E. Karnm 2 Filed; June 8, 1971 AttorneyStowel1 & Stowell Appl. No.: 151,058

[52] (1.8. CI. ..l28/2 F, 128/240, 128/276 [51] Int. Cl. ..A6 1b 10/00 [58] Field of Search ..128/2 B, 2 F, 2 R, 128/4,'5, 240, 241, 276-278 [561 References Cited UNITED STATES PATENTS 1,843,169 2/1932 McKes son ..128/240 3,526,218 9/1970 Reiss et a1. ..128/2 F 2,142,624 l/l939 Williams ..l28/278 2,148,541 2/1939 Dierker ..l28/241 3,626,928 12/1971 Barringer et a1. ..128/2 B 7 ABSTRACT A device for use in proctosigmoidoscopic examinations for directing a pressure liquid, such as water, a saline solution and/or diagnostic dyes to a predetermined proctosigmoid zone and for withdrawing the injected fluid, feculent and mucoid debris associated therewith including first and second hollow parallel nonconcentric tubular members, means connecting one of the tubular members to a source of liquid under pressure and further conduit means selectively connecting the other of the hollow tubular members to a source of reduced pressure and/or a collector maintained at a reduced pressure. The withdrawing function and/or spraying may be continuous or intermittent.

4 Claims, 2 Drawing Figures PATENILLPZKYQQIQYS 35,751

- INVENTOR SEYMOUR KATZ BACKGROUND The device of the present invention is particularly adapted to assist the 'endoscopist in evaluating the bowel without the alterations created by enemata, to maintain optimal visualization free of obscuring debris and to obtain material from multiple foci or from the entire visualized 25 cm length recto-sigmoid for cytology, bacteriology, and parasitologic analyses, all of these aims and objects being accomplished with a minimum of discomfort to the patient.

It is, therefore, a primary object of the present invention to provide an instrument which combines the advantages of water, saline or other liquid spray under controlled pressure with a suction unit adapted for cleansing and/or collection of multiple rectal aspirates or one continuous sample.

While proctosigmoidoscopic examinations have been performed without enema preparation if there is profuse diarrhea, gastrointestinal hemorrhage, and especially. if inflammatory bowel disease is suspected, and while such procedures provide a true picture of the mucosa, the examination is often hampered by obstructing feculent and mucoid debris.

debrisfrom suspicious areas as well as provide an isotonic medium for collection of individual samples. These can easily be obtained and identified from multiple sites simply by inserting a new collection tube for each area. The tubes may becalibrated to permit the addition of an equal volume of 95 percent alcohol necessary for cytologic studies.

It will also be appreciated by those skilled in the profession that the instrument permits study of multiple areas either too friable or too numerous to biopsy, or

of locations associated with an increased hazard with biopsy, i.e., above the peritoneal reflection.

Ulcerative colitis carries a pre-malignant potential and the pre-cancerous changes are usually patchy and are frequently located in the distal colon and rectum.

. However, diffuse inflammatory involvement of a thinwalled excessively friable bowel does not lend itself to multiple biopsies. The present instrument permits a direct sampling of the suspect area, and even in the absence of specific lesions, a circumferential universal sweep employing simultaneous saline lavage and suction on withdrawing the proctoscope will provide a sig nificant cytologic specimen.

Through the use of the instrument of the present invention, diagnostic accuracy may be enhanced in detecting changes in other pre-malignant states (e.g., familial polyposis of colon) and in follow-up examinations after resection of malignancies. The instrument may also provide a spray lavage directed through and beyond the length of the proctoscope to obtain cytologic materialfrom more proximal left colonic lesions.

Additional applications of the device of the present invention include direct aspiration of focal or ulcerated areas for bacteriologic cultures and parasitologic (e.g., ameba) examinations.

The invention will be more particularly described in reference to the accompanying drawing wherein:

FIG. 1 is a perspective view of apparatus embodying the present invention; and

FIG. 2 is a perspective view of one form of the instrument constructed in accordance with the teachings of the invention.

In general the invention is provided by a device for use in proctosigrnoidoscopic examinations comprising:

first and second hollow tubular members arranged in generally parallel relationship;

each of said first and second members terminating in open generally contiguous ends;

means connecting the other end of the first tubular member to a source of liquid under pressure; and means for selectively connecting the end of the second tube to a source of reduced pressure and/or a collector maintained at a reduced pressure.

Now referring to the drawings, the improved instrument generally designated 10 includes first and second hollow tubular members 12 and 14. In the preferred arrangement, the tubes 12 and 14 extend in generally parallel relationship and terminate in contiguous open ends 16 and 18.

In general, the tubes have an insertable length of about 30 centimeters. However, depending on the particular use of the device, they may be shorter or longer and a length based on the form of the endoscope with which it is to be used should be considered.

Tube 12 has an internal diameter of about 4 mm while tube 14 has an internal diameter of about 3 mm. Again these diameters are not necessarily critical as long as the tube 12 22 and large enough to provide sufficient flushing liquid and tube 14 large enough to withdraw the desired sample.

End 20 of tube 12 is connected to a handle forming header tube 22 which is provided at its other end 24 with a suitable fitting 26 through which pressure liquid is directed to the header 22and tube 12 as to be further described hereinafter.

A valve, 28 may be provided at end 20 of tube 12, which valve may be provided with a thumb-screw trigger mechanism 30 for use when a constant supply of pressure liquid is connected to fitting 26 of the device.

Tube 14, the suction barrel or tube, is connected to a header 32 at end 34. The lower end of header 32 is provided with a fitting 36 for connection to a source of reduced pressure, not shown. The source of reduced pressure may comprise a simple aspirator or conven tional vacuum pump.

Between headers 22 and 32 are secured plate members 38 which, together with the headers, form a handle for the instrument.

A branch tube 40 has one end connected to the vacuum header 32 and its other end 42 terminating in the upper end of a collector tube 44. The system also includes a three-way valve 46, having actuator 48, which valve is positioned in suction tube or barrel 14 adjacent the suction header 32.

A line or tube 50 connected at one end to the threeway valve 46 terminates at its other end 52 at the upper end of collector tube 44. It will be noted that both tubes 40 and 50 pass through, for example, a rubber stopper 54, which stopper connects the collector tube 44 to the assembly. Through the operation of valve 46 via control handle 48, suction from its source may be directly connected to tube 14, to the tube 14 via the collector tube 44 or the suction may be cut off from the tube 14.

The collector tube 44 may be graduated to permit collection of predetermined sample quantities or as hereinbefore set forth to permit the addition to the tube of a volume of alcohol necessary for cytologic studies.

As illustrated in FIG. 1, the liquid header 22 may be connected to a commercial dental irrigating apparatus 60 having a reservoir 62 for saline solution, diagnostic dyes or the like. The irrigating unit 60 may include controls as at 64 and 66 whereby pulse rate and volume of its output may be controlled.

Where a commercial dental type irrigating means such as shown at 60 is not employed, the header 22 may be connected to some other source of pressure liquid, such as tap water, via flexible tube 68, as shown in FIG. 2.

In use of the instrument, the pair of tubes 12 and 14 are inserted through the hollow lumen of an endoscope or connected to the barrel of an endoscope, or sigmoidoscope and the combined instruments are inserted into the proctosigmoid area. Suction is controlled by the three-way valve 46 to permit multiple, interrupted, samples or one continuous aspirate. With the header 22 connected to tap water, the pressure trigger is employed to control water volume which can be significantly increased to maintain visualization even in the presence of active lower gastrointestinal hemorrhage or such control may be had through the use of the dental irrigating device 60.

I claim: 1. A device for use in proctosigmoidoscopic examinations comprising:

first and second hollow tubular members arranged in generally parallel nonconcentric relationship; each of said first and second members terminating in open generally contiguous ends; means adapted to connect the other end of said first tubular member to a source of liquid under pressure; connection means adapted to be connected to a source of reduced pressure; a collector connected to said connection meand and maintained at a reduced pressure; means selectively connecting the other end of said second tube to said connection means or said collector. 2. The invention defined in claim 1 wherein said selective connecting means comprises a three-way valve.

3. The invention defined in claim 1 wherein said selective connecting means comprises a three-way valve and said collector comprises a removable sample tube.

4. The invention defined in claim 2 including a second valve means for controlling the flow of pressure liquid from a source to said first tube.

I 10! t l 

1. A device for use in proctosigmoidoscopic examinations comprising: first and second hollow tubular members arranged in generally parallel nonconcentric relationship; each of said first and second members terminating in open generally contiguous ends; means adapted to connect the other end of said first tubular member to a source of liquid under pressure; connection means adapted to be connected to a source of reduced pressure; a collector connected to said connection meand and maintained at a reduced pressure; means selectively connecting the other end of said second tube to said connection means or said collector.
 2. The invention defined in claim 1 wherein said selective connecting means comprises a three-way valve.
 3. The invention defined in claim 1 wherein said selective connecting means comprises a three-way valve and said collector comprises a removable sample tube.
 4. The invention defined in claim 2 including a second valve means for controlling the flow of pressure liquid from a source to said first tube. 